HomeMy WebLinkAboutALYESKA Block 6A Tract 2
APPLIC-NT FILLS OUT UPPER' HAl ONLY
Mailing Address i//'~? ./?
Zip Code ~.? f/> ~ '~L--
/./. Phone
Type of Residence / · '
M ngle Family
ultiple Family No. of Bedrooms
[] Other
'{~,,Indivldual ATTACH WELL LOG. A well log is required for all wells drilled sincex~rbne 1975.'
LJ Community For wells drilled prior to that date, give well depth (attach log if availall~e)~ ......
[] Public Utility
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time , Time
Date Date Date Date \/
Inspector ' ("~D-~'~\'~,?~ \
Inspector Inspector Inspect°r 0 ~ '"~3', ~'~ ~-t~
/ DFPT C~
· ,!.',.tt I 9
RECEIVED
( ".,~ APPROVED BEDROOMS *GONDITION$ OF APPROVAL
( ) DISAPPBOVED
(D A~TE~_O: T ~O N-- A ~A~P~R ~A~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023 (3182)
CHEMICAL & Ga '~OGICAL LABORATORIES ~ ALASKA, INC~ ~
~,,,- ~o..i.,..-~ TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
rinking Wet Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
; I.D. NO.
Water System Name' Phone No.
Mailing Address
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
,, I I
Time
Colleoted
Collected
By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Sample too long m transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new samale.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
El" Membrane Filter
Lab Ref. No. Result* Analyst
II-1-I
JFT'I
*No. Of colonies/100 mi. or NO. of Posdive portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date C ollecte~ Source
Data Received .Time Received __ p.m. Lab. NO.
Presumptive Z0ml 10mi 10mi 10mi 10mi 1.0mi 0,1mi
24 Hours
48 HOURS
Confirmatory
24 Hours
,48 Hours
EMB
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
Broth 24 hours:
Broth 48 hours:
.:[Omi Tubes Positive/Total 1Omi Portions
Collform/100ml
BGB
Collform/100ml
Date
Tlme~ a.m.
I~.m,